Right coronary system grafts: alone or together with left system grafts--angiographic results
Ozer Kandemir1, Hilmi Tokmakoglu, Tevfik Tezcaner
1Department of Cardiovascular Surgery, Karaelmas University, School of Medicine, Zonguldak.
Insights
Sequential anastomosis of the right posterior descending artery (RPDA) offers superior long-term graft patency compared to individual grafts, especially in vessels with good run-off. This technique enhances coronary artery bypass grafting outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Anastomosis Techniques
- Graft Patency Research
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for coronary artery disease.
- Graft patency is a key determinant of long-term CABG success.
- Optimizing anastomosis strategies for specific coronary territories, like the right posterior descending artery (RPDA), is essential.
Purpose of the Study:
- To compare the long-term graft patency of sequential versus individual right posterior descending artery (RPDA) anastomosis.
- To evaluate the influence of vessel run-off capacity on graft patency in different anastomosis techniques.
Main Methods:
- Retrospective analysis of 242 patients undergoing CABG between 1994 and 2003.
- Group 1: Individual right system grafts in RPDA position (n=139).
- Group 2: Sequential RPDA anastomosis with the left system (n=103).
- Coronary angiographic data were used to calculate patency rates for each group and vessel quality.
Main Results:
- Overall graft patency was significantly higher in the sequential group (78.6%) compared to the individual group (66.2%) (p=0.04).
- When the RPDA had good run-off capacity, patency rates were 85.2% for sequential grafts versus 69.1% for individual grafts.
- The mean follow-up interval to angiography was comparable between groups (50.6 months vs. 57.5 months).
Conclusions:
- Sequential anastomosis, particularly 'snake grafts,' demonstrates excellent long-term patency for the RPDA when good run-off is present.
- Sequential anastomosis of right and left coronary systems is a viable and effective strategy.
- This technique may improve outcomes in coronary artery bypass grafting.
Purpose:
The aim of this study is to compare the long-term graft patency between patients who had sequential or individual right posterior descending artery (RPDA) anastomosis.
Materials And Methods:
Two hundred and forty-two patients underwent coronary artery bypass grafting (CABG) between June 1994 and December 2003. They were examined retrospectively with respect to coronary angiograghic data. [Group 1] Individually right system grafts in RPDA position (n=139). [Group 2] RPDA anastomosis sequentially with left system (n=103). Patency rates for posterior descending arteries in each group were separately calculated for each vessel quality category.
Results:
The mean interval from operation to angiography was 50.6+/-48.9 months in group 1 vs 57.5+/-39.2 months in group 2 respectively. The overall patency rate was 66.2% (92/139) in group 1 and 78.6% (81/103) in group 2 (p=0.04). When the RPDA has good run-off capacity, the patency rate was 69.1% in group 1 and 85.2% in group 2.
Conclusion:
When the RPDA has good run-off capacity, snake grafts show excellent results and right and left coronary systems could be anastomosed sequentially.
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